Applicability of estimating glomerular filtration rate equations in pediatric patients: comparison with a measured glomerular filtration rate by iohexol clearance.
Applicability of estimating glomerular filtration rate equations in pediatric patients: comparison with a measured glomerular filtration rate by iohexol clearance.
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DOI：
10.1016/j.trsl.2014.10.004
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Langman CB
中科院分区：
文献类型：
--
作者：
Deng F;Finer G;Haymond S;Brooks E;Langman CB
肾小球滤过率（eGFR）的估计值在临床医学中已成为测量GFR（mGFR）的替代方法，但在临床实践中比较它们的研究很少。我们在常规实践中通过碘海醇清除率测定了81例连续儿童的mGFR，并使用mGFR程序时收集的血清肌酐、胱抑素C和尿素氮，通过14个标准方程计算了eGFR。采用非参数Wilcoxon检验、斯皮尔曼相关性、Bland-Altman分析、偏倚（中位差）和准确性（P15、P30）比较mGFR与eGFR。整个研究组的mGFR为77.9±38.8mL/min/1.73 m2。在Bland-Altman分析中，14个估计方程中的8个证明了与mGFR值无显著差异的值，并证明了偏倚较低。这8个方程中的3个基于肌酐和胱抑素C的组合（Schwartz等人，2009，2012; Chehade等人），P15和P30的准确率最高，分别为60%和80%。在10例单肾患者、7例肾移植患者和另外11例身材矮小儿童中，与mGFR相比，三个方程的值具有低偏倚且无显著差异。总之，采用半胱氨酸蛋白酶抑制剂C、肌酐和生长参数的三个方程以上级方式优于基于肌酐或半胱氨酸蛋白酶抑制剂C的单变量方程，并且在单肾、肾移植和/或身材矮小的特定儿科患者中也具有良好的适用性。因此，我们建议在儿科临床实践中计算eGFR仅采用多变量方程。
Estimates of glomerular filtration rate (eGFR) have become popular in clinical medicine as an alternative to measuring GFR (mGFR) but there are few studies comparing them in clinical practice. We determined mGFR by iohexol clearance in 81 consecutive children in routine practice and calculated eGFR from 14 standard equations using serum creatinine, cystatin C, and urea nitrogen that were collected at the time of the mGFR procedure. Non-parametric Wilcoxon test, Spearman Correlation, Bland–Altman analysis, bias (median difference) and accuracy (P15, P30) were used to compare mGFR to eGFR. For the entire study group, the mGFR was 77.9±38.8mL/min/1.73 m2. Eight of the 14 estimating equations demonstrated values without a significant difference from the mGFR value and demonstrated a lower bias in Bland–Altman analysis. Three of these eight equations based on a combination of creatinine and cystatin C, (Schwartz et al. 2009, 2012; Chehade et al.), had the highest accuracy with approximately 60% of P15 and 80% of P30. In 10 patients with a single kidney, seven with kidney transplant, and 11 additional children with short stature, values of the three equations had low bias and no significant difference when compared with mGFR. In conclusion, the three equations that employed cystatin C, creatinine, and growth parameters performed in a superior manner over univariate equations based on either creatinine or cystatin C, and also had good applicability in specific pediatric patients with single kidneys, those with a kidney transplant, and/or short stature. Thus, we suggest that eGFR calculations in pediatric clinical practice employ only a multivariate equation.
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影响因子：
3.7
作者：
Feng JF;Qiu L;Zhang L;Li XM;Yang YW;Zeng P;Guo XZ;Qin Y;Liu HC;Han XM;Li YP;Xu W;Sun SY;Wang LQ;Quan H;Xia LJ;Hu HZ;Zhong FC;Duan R
通讯作者：
Duan R
DOI：
10.1056/nejmoa1114248
发表时间：
2012-07-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Inker LA;Schmid CH;Tighiouart H;Eckfeldt JH;Feldman HI;Greene T;Kusek JW;Manzi J;Van Lente F;Zhang YL;Coresh J;Levey AS;CKD-EPI Investigators
通讯作者：
CKD-EPI Investigators
影响因子：
3
作者：
Bökenkamp, A;Domanetzki, M;Brodehl, J
通讯作者：
Brodehl, J
影响因子：
3
作者：
Bouvet, Yann;Bouissou, Francois;Chatelut, Etienne
通讯作者：
Chatelut, Etienne
影响因子：
19.6
作者：
Gao, Anja;Cachat, Francois;Chehade, Hassib
通讯作者：
Chehade, Hassib